Multiple lumen catheter

ABSTRACT

The invention provides a cylindrical elongate body extending from a proximal to a distal end, the body defining two similar longitudinally extending lumens separated by a septum and a further lumen defined within the septum, a tip extending from the distal end of the body defining a part of the further lumen, a connector at the proximal end, tubes coupled to the connector and in fluid communication through the connector one with each of the respective lumens, the body defining openings providing access one to each of the longitudinally extending lumens, the openings being spaced from one another longitudinally of the body and the further lumen extending longitudinally beyond the longitudinally extending lumens and through the tip, the further lumen terminating at an opening at the distal end of the tip and the tip being convergently tapered as it extends longitudinally from the body and the longitudinally extending lumens being blocked immediately adjacent and distally of the openings.

This application is a continuation of application Ser. No. 08/205,331filed on Mar. 3, 1994 and now U.S. Pat. No. 5,472,417, which is acontinuation of application Ser. No. 07/785,351 filed on Oct. 30, 1991and now abandoned, which is a continuation of application Ser. No.07/288,364 filed on Dec. 22, 1988 and now U.S. Pat. No. 5,195,962.

BACKGROUND OF THE INVENTION

This invention relates to a multiple lumen catheter and moreparticularly to such a catheter for insertion into a vein of a patientto be used in haemodialysis treatments. The invention also relates tomethods for manufacturing the multiple lumen catheter.

FIELD OF THE INVENTION

Multiple lumen catheters have been available for many years for avariety of medical purposes. It is only in recent years, however, thatsuch catheters have been developed for use in haemodialysis. The generalform of multiple lumen catheters goes back to as early as 1882 whenPfarre patented such a catheter in the United States under U.S. Pat. No.256,590. This patent teaches a flexible dual lumen catheter which isused primarily for cleaning and drainage of, for example, the bladder,rectum, stomach and ear. In this type of catheterization, the catheteris introduced into an existing body orifice without the use of anypuncturing needle or guidewire.

More recently, a catheter was developed and patented by Blake et alunder U.S. Pat. No. 3,634,924. This 1972 patent teaches a double lumencardiac balloon catheter which is introduced into a large vein and theballoons inflated to control the flow in the vein. The catheter can infact be placed by using the balloon as sails to move the blood into orthrough the heart to a position where the catheter takes up its intendedfunction. This patent uses two lumens and teaches a method of making atip which involves the use of a plug and a wire which retains the shapeof one of the lumens during formation of the tip in a mouldingtechnique.

Further patents which teach multiple lumen catheters for general useincluding the following U.S. Pat. Nos: 701,075; 2,175,726; 2,819,718;4,072,146; 4,098,275; 4,134,402; 4,406,656 and 4,180,068.

Vascular catheter access by surgical cut-down techniques has been knownto the medical procession for many years and, in fact, can be tracedback to the 17th century. However, it was only with the introduction ofthe Seldinger technique in 1953 or thereabouts that a new approach couldbe used to improve vascular access. This technique was taught in anarticle published by Seldinger resulting from a presentation made at theCongress of the Northern Association of Medical Radiology at Helsinki inJune of 1952. The technique essentially involves the use of a hollowneedle to make an initial puncture and then a wire is entered throughthe needle and positioned in the vessel. The needle is withdrawn and thecatheter is entered percutaneously over the wire which is laterwithdrawn. With this technique it became possible to make less traumaticvascular access and has now become the accepted method of performingaccess in numerous medical techniques. One of these techniques which hasbeen the subject of much research and development, is haemodialysis.

Haemodialysis can be defined as the temporary removal of blood from apatient for the purpose of extracting or separating toxins therefrom andthe return of the cleansed blood to the same patient. Haemodialysis isindicated in patients where renal impairment or failure exists, that is,in cases where the blood is not being properly or sufficiently cleansed,(particularly to remove water) by the kidneys.

In the case of chronic renal impairment or failure, haemodialysis has tobe carried out on a repetitive basis. For example, in end stage kidneydisease where transplantation of kidneys is not possible or for medicalreasons is contra-indicated, the patient will have to be dialysed about100 to 150 times per year. This can result in several thousand accessesto the blood stream to enable the active haemodialysis to be performedover the remaining life of the patient.

Towards the end of 1960, Dr. Stanley Shaldon and colleagues developed,in the Royal Free Hospital in London, England, a technique forhaemodialysis by percutaneous catheterization of deep blood vessels,specifically the femoral artery and vein. The technique was described inan article published by Dr. Shaldon and his associates in the Oct. 14th,1961 edition of The Lancer at pages 857 to 859. Dr. Shaldon and hisassociates developed single lumen catheters having tapered tips forentry over a Seldinger wire to be used in haemodialysis. Subsequently,Dr. Shaldon and his colleagues began to insert both inlet and outletcatheters in the femoral vein and this was reported in the BritishMedical Journal of Jun. 19th, 1963. The purpose of providing both inletand outlet catheters in the femoral vein was to explore the possibilityof a "self-service" approach to dialysis. Dr. Shaldon was subsequentlysuccessful in doing this and patients were able to operate reasonablynormally while carrying implanted catheters which could be connected tohaemodialysis equipment periodically.

Some use was made of a flexible dual lumen catheter inserted by surgicalcut-down as early as 1959. An example of such a catheter is that ofMcIntosh and colleagues which is described in the Journal of theAmerican Medical Association of Feb. 21, 1959 at pages 137 to 138. inthis publication, a dual lumen catheter is made of non-toxic vinylplastic and described as being inserted by cut-down technique into thesaphenous vein to the inferior vena cava.

The advantages of dual lumen catheters in haemodialysis is that only onevein access need be affected to establish continued dialysis of theblood, because one lumen serves as the conduit for blood flowing fromthe patient to the dialysis unit and the other lumen serves as a conduitfor blood returning from the dialysis unit to the patient. Thiscontrasts with prior systems where either two insertions were necessaryto place the two catheters as was done by Dr. Shaldon, or a singlecatheter was used with a complicated dialysis machine whichalternatively removed blood and returned cleansed blood.

The success of Dr. Shaldon in placing catheters which will remain inplace for periodic haemodialysis caused further work to be done withdifferent sites. Dr. Shaldon used the femoral vein and in about 1977 Dr.Uldall began clinical testing of a subclavian catheter that would remainin place. An article describing this was published by Dr. Uldall andothers in Dialysis and Transplantation, Volume 8, No. 10, in October1979. Subsequently Dr. Uldall began experimenting with a coaxial duallumen catheter for subclavian insertion and this resulted in CanadianPatent No. 1,092,927 which issued on Jan. 6, 1981. Although thisparticular form of catheter has not achieved significant success in themarket place, it was the forerunner of dual lumen catheters implanted inthe subclavian vein for periodic haemodialysis.

The next significant step in the development of a dual lumen catheterfor haemodialysis is U.S. Pat. No. 1,150,122 to Martin who produced acatheter which achieved some commercial success. The catheter avoidedthe disadvantages of the Uldall structure.

A subsequent development is shown in U.S. Pat. No. 4,451,252 also toMartin. This utilizes the well known dual lumen configuration in whichthe lumens are arranged side-by-side separated by a diametric septum.The structure shown in this patent provides for a tip making it possibleto enter a Seldinger wire through one of the lumens and to use this wireas a guide for inserting the catheter percutaneously. Patents to thistype of structure followed and include European Patent Application toEdelman published under No. 0 079 719, U.S. Pat. Nos. 4,619,643;4,583,968; 4,568,329 and U.S. Design Pat. No. 272,651.

All of the above examples of haemodialysis catheters suffer from thedisadvantages that they can not be used readily for intravenousinjection of liquid medication. A person who is using haemodialysistherapy with a dual lumen catheter will have to receive a needle forintravenous injection when medication of this kind is required. It wouldbe desirable that the catheter not only perform the function ofhaemodialysis, but also provide a facility for intravenous injectionwithout further puncturing of the patient's veins. It is one of theobjects of the present invention to provide such a catheter.

The foregoing problems associated with haemodialysis catheters may onsome instances be specific to the treatment. However, the catheter ofthe present invention, in overcoming the disadvantages of the prior artof renal dialysis catheters, provides a catheter which has utility inother procedures. Accordingly, although the present description isdirected to haemodialysis, such use is exemplary and it will be evidentthat catheters according to the invention may be used for otherprocedures.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other aspects of the invention will now be described withreference to the accompanying drawings, in which:

FIG. 1 is a diagrammatic view of a triple lumen catheter according to apreferred embodiment of the present invention, inserted into thesubclavian vein of a patient;

FIG. 2 is a diagrammatic perspective view of the catheter drawn to alarger scale than that used in FIG. 1;

FIG. 3 is an enlarged sectional view of the distal end of the catheterof FIG. 1 drawn on line 3--3 of FIG. 2;

FIGS. 4 and 5 are enlarged sectional views taken on the lines 4--4, 5--5of FIG. 3, respectively, and showing complete sections;

FIG. 6 is an end view of the catheter in the direction generally ofarrow of FIG. 3;

FIG. 7 is a sectional view of a trident-shaped branching connector seenat the proximal end of the catheter in FIG. 2 and drawn to a largerscale;

FIGS. 8, 9, 10 and 11 are diagrammatic perspective views of an end ofthe catheter showing the various steps in the manufacture of thetrident-shaped branching connector and associated parts;

FIG. 12 is a sectional view of the connector after assembly;

FIG. 13 is a view similar to FIG. 3 of the distal end of anotherembodiment of the present invention;

FIG. 14 is a sectional view taken on line 14--14 of FIG. 13;

FIG. 15 is a sectional view of a further embodiment of the catheter;

FIG. 16 is a perspective view of a plug for use in making yet anotherembodiment of the catheter;

FIG. 17 is a sectional view of still another embodiment of the catheterand using a separate bonded tip;

FIG. 18 is a sectional view illustrating an alternative method ofmanufacturing a tip according to the invention; and

FIG. 19 is a side view of a tip made using the method illustrated inFIG. 18.

DESCRIPTION OF PREFERRED EMBODIMENTS

The invention will be described in detail with reference to a preferredembodiment to be used for haemodialysis. However the drawings anddescription are exemplary of the invention and unless otherwise state,are not intended to be limited by its restraints of size and propertiesdictated by haemodialysis procedures.

Reference is made first to FIG. 1 of the drawings which illustrates atriple lumen catheter, indicated generally by reference numeral 20,according to a preferred embodiment of the present invention, andshowing by way of example, a patient receiving the catheter in thesubclavian vein using a Seldinger wire 21. The catheter is to be usedfor haemodialysis treatment and could of course also be entered in asimilar fashion in the femoral vein.

The catheter 20 is secured to a conventional dressing 22 by anattachment fitting 23 having wing tabs 24, and the dressing 22, in turn,is secured to the skin of the patient. As shown, the catheter 20 passesthrough the dressing 22 and, as can be seen in broken outline, anelongate and flexible cylindrical body 26, formed of a polyurethaneextrusion, is inserted through the skin and into the subclavian vein inthe downstream direction. The catheter 20 has at its distal end 28 aconical tapered tip 29 which is described in greater detail below. Theother end of the body 26 is a generally trident-shaped branchingconnector 30, which protrudes outwardly from and is secured by dressing22. Cylindrical blood extraction and return tubes 23, 34 and anintravenous (IV) tube 35 are attached to the trident-shaped branchingconnector 30, a full description of which is provided below. For themoment it is sufficient to state that these tubes are connected tolumens running through the body 26.

FIG. 2 shows the catheter 20 in greater detail. The body 26 has at itsproximal end the connector 30 for receiving the blood extraction andreturn tubes 32, 34. These tubes terminate at their outer ends inrespective female luer fittings 36, 37 for connection to complementarymale luer fittings (not shown) leading to a dialysis machine, and carryclosure clamps 38 (one of which is shown) to selectively close thetubes.

The IV tube 35 terminated at its outer end in a luer lock fitting 39 forreceiving a syringe or male luer lock connector.

The wing tabs 24, sometimes known as suture wings, are formed integrallywith a central tubular portion 40 which can rotate on the body 26 and isretained in place by a shoulder on the end of the connector 30 and asecond shoulder in a reinforcing portion 42 so that the catheter 20 canbe rotated relative to the tabs 24. This rotation is sometimes necessaryafter insertion of the catheter 20 to re-orientate intake side aperturesin the distal end 28 if the apertures happen to be occluded byengagement with the wall of the vein. Details of the apertures areprovided below.

As will be described, the reinforcing portion 42 is blended into thebody 26 over the length of the portion and assists in strengthening thecatheter to minimize the likelihood of kinking. Also, the portion 42assists in sealing the puncture site where the catheter enters thepatient.

As will be described in more detail with reference to subsequent views,the tube 35 is aligned with a central lumen to permit the Seldinger wire21 to pass through the catheter. The wires exists distal end 28 ofcatheter body 26 through a tip aperture 64 at the apex of at tip 29which is essentially conical so that the catheter can slide over thewire and into the patient during insertion. The extraction and returntubes 32, 34 are linked at connector 30 with lumens in the body 26 toconnect with respective groups of side apertures 44, 45 (some of whichcan be seen in this view) near the distal end of the catheter 28. As aresult, when inserted and in use, blood can be removed and returned in aclosed loop with a haemodialysis machine using the tubes 32, 34. Betweentreatments the tube 35 is available for intravenous infusion of liquidmedicaments.

Reference is next made to FIGS. 3 to 6 of the drawings which illustratethe distal end 28 including tip 29. The body 26 comprises an outer wall46 and an integral septum 48 extending diametrically across the body 26and defining an extraction lumen 50 and a return lumen 52, both lumensbeing generally C-shaped in cross-section and extending from theproximal end towards the distal end. As best seen in FIG. 4, a bulbousmiddle portion 53 of the septum 48 projects into the lumens 50, 52 andcontains the intravenous (IV) lumen 54 which extends along thelongitudinal axis of the body portion 26 from the proximal end to thedistal end. This lumen is an extension of the IV tube 35 and isproportioned in this embodiment to receive a 0.038 inch diameterSeldinger wire.

The extraction lumen 50 is blocked short of the tip 29 by a first insert56 which is formed of polyurethane and bonded in place using a suitablesolvent such as cyclohexanane, leaving a hollow extension A ofextraction lumen 50 distal of first insert 56. Extraction apertures 44are provided in the outer wall 46 of the cylindrical portion 26, justshort of the insert 56, to permit blood to flow from the patient's veininto the extraction lumen 50 and thus through the connector 30 to theextraction tube 32 and the dialysis machine. It should be noted that theapertures 44 are conveniently circular but may be of any suitable shapeor size including scaphoid. Also, further extraction apertures may beprovided around the lumen 50 as required consistent with the aperturenearest the tip being immediately adjacent the insert 56 to minimizedead spaces.

The return lumen 52 is similarly blocked by a second insert 60immediately adjacent the last of several return apertures 45. This lastaperture is positioned closer to the tip 29 than is the last of theintake apertures 44 in the extraction lumen 50 to minimize the risk ofcross flow as returning blood finds its way back into the lumen 50. Ahollow extension B of return lumen 52 remains distal of second insert60. Although some cross-flow is not critical, excess cross-flow willextend the time needed for haemodialysis.

As can be seen in FIGS. 3 and 6, the tip 29 is smoothly rounded at theend 28 of the catheter and tapered slightly gently to facilitateinsertion of the catheter 20 into a patient. As mentioned previously,the catheter is intended to be used with a Seldinger wire. It is,therefore, clearly desirable that the tapered tip 29 be concentric withthe axis of the body 26 and of the lumen 54. Accordingly, the centrallylocated IV lumen 54 extends to the tip 29 and terminates at a circularIV aperture 64.

The catheter 20 is made from a length of cylindrical polyurethaneextrusion forming the cylindrical body 26. The extrusion is cut to therequired length and the ends formed by further operations. The formationof the tapered tip 29 will be described with reference firstly to FIG.3, followed by a description of the formation of the connector 30.

Before shaping the tapered tip 29, the inserts 56, 60 are positioned andaffixed in the respective lumens 50, 52 as shown in FIG. 3. The insertsare shaped to the cross-section of the lumens and affixed as previouslydescribed. A cylindrical wire 66 (shown in chain dotted outline), ofcorresponding diameter to that of the guide wire 21 (FIG. 2), isinserted through the IV lumen 54 to extend from the distal end of thetubing which is then located in a conical tapered mould 68 (shown inchain-dotted outline). The extrusion is heated by R.F. and as it softensit is pushed into the mould 68 in the direction of arrow D, such thatthe outer wall 46 and the septum 48 merge at the tip 29. The end of thebody assumes a conical tapered shape with a radiused end and thematerial masses in the lumens 50, 52 forming ends 70, 72. The IV lumen54 retains its internal shape because it is supported on the wire 66.The now tapered tip is cooled to some extent and then removed from themould 68 and allowed to cool further and harden.

The deformation of the tip results in a thickening of the outer wall 46and septum 48 to provide a concentration of material substantiallyexceeding the concentration of material in the main catheter body, andthis has the effect of stiffening the tip, which facilitates insertionof the catheter.

Because the wire 66 is not deflected at any time from its normalstraight condition during the moulding operation, there is no energystored in the wire and consequently there is no tendency for the wire todeflect the tip from the desired orientation after removal from themould 68.

The wire can therefore be left inside the tip during cooling. Theapertures 44, 45 are then cut or otherwise formed in the outer wall 46of the body 26. Also, because the extrusion is symmetrical about thewire, the deformed material at the tip will move evenly to each side ofthe central septum. The resulting similar masses at ends 70,72 of thelumens will cool and shrink equally so that the tip will remainconcentric about the central or IV lumen 54. This will result in a wellformed tapered tip.

The method of manufacture of the trident-shaped branching connector 30and reinforcing portion 42 will next be described with reference toFIGS. 7 to 12. The figures are arranged in order of the steps used inthe manufacture and it will be seen in FIG. 7 that the extruded body 26has received a short sleeve 71 of polyurethane and preferably the samecolor as that used for the body. The sleeve 71 is snug fit on thecylindrical body 26 and after positioning on the body, the assembly ismoved into a heated moulded 73 which has a frustro-conical interior wall75 designed to deform the sleeve 71 to create the blended reinforcingportion 42 shown in FIG. 2. If preferred, suitable shaped mandrels canbe placed inside the lumens of the body 26 to ensure that the lumens arenot deformed while the collar is shaped in the mould 73. The sleeve 71is heated and the body pushed into the heated mould 73 so that materialflows to the desired shape.

The upper edge of the sleeve 71 (as drawn) forms a shoulder and ispositioned for engagement with the attachment fitting 23 shown in FIG. 2to locate this fitting longitudinally on the body.

After completing the process illustrated in FIG. 7, the fitting 23 isslipped over the end of the body 26 and into engagement with the sleeve71. The fitting is a loose fit so that it can rotate freely on the body26. The positioning can be seen in FIG. 8 which also shows the completedreinforcing portion 42 and how it blends into the body 26.

Next another sleeve 74 is engaged over the end of the tube 26 and, ifthe first sleeve has been positioned correctly, the sleeve 74 will bepositioned so that its trailing end becomes flush with the end of thebody 26 as shown in FIG. 9. The sleeve 74 should not be pushed tightlyagainst the attachment fitting 23 in order to provide clearance of freemovement of the fitting. With the sleeve in position, a set of deformingmandrels are brought into play as seen in FIG. 9. There are threemandrels, one for each of the lumens. The two outer mandrels 76, 78 aremirror images of one another and positioned about a central mandrel 80.The intent of the mandrels are to form the corresponding lumens to haveconical outer portions for receiving shaped ends of the tubes 32, 34 and35 (FIG. 2) as will be described with reference to FIG. 12.

The mandrels 76, 78 have respective leading ends 82, 84 which areproportioned simply to provide location as they enter correspondinglumens 50, 52 and similarly, a leading portion on the mandrel 80 isproportioned to engage the central lumen 54. The leading portions 82, 84and 86 blend into respective conical portions 88, 90 and 92 which arearranged to complement one another so that the cones will flairoutwardly to receive the tubes. Of course for simplicity of engagement,each of the mandrels is supported from shanks which are arranged inparallel so that the mandrels can be brought into the extrusionlongitudinally and deformation will take place simply because theconical portions are larger than the lumens and the material around thelumens will be forced outwardly under the influence of heat provided byheating the mandrels. The second sleeve 74 supports the extrusion whichis itself insufficient to support this deformation as the size isincreased.

it will be seen in FIG. 10, that after the mandrels are engaged, thesecond sleeve 74 and contained portion of the extrusion are expanded toform connector 30 and, after completion, the appearance of connector 30will be as shown in FIG. 11.

Reference is next made to FIG. 12 which shows the engagement of thetubes 32, 34 and 35 in the connector 30. These tubes have theirengagement ends deformed to thin the wall and this is done by conicaldeformations so that the outer surface of the tubes are slightly conicalto engage the corresponding internal cones 94, 96 and 98 shown in FIG.11 and formed by the use of the mandrels. It will be seen in FIG. 12that the result in assembly is compact, and provides a relatively smoothinternal surface to minimize the risk of blood damage caused byturbulence as blood flows through the tubes and associated lumens 32, 34and 50, 52. Similarly, the tube 35 is engaged so that there is nointerference with the Seldinger wire which will slide freely throughthis tube and lumen 54.

The tubes are attached in the connector 30 using a suitable solvent in asimilar fashion to the attachment of the plugs 56, 60 described withreference to FIG. 3.

it is of course possible to make the assembly starting with the tridentshaped structure and then add the fitting 23 from the distal end of thebody before ending by adding and forming sleeve 71.

In use, as mentioned above, the catheter 20 is inserted such that itpoints downstream in the patient's vein, that is, the extractionaperture 44 are upstream of the return apertures 45, which, in turn, areupstream of the IV tip aperture 64. When a treatment is in progress theextraction tubes 32, 34 are connected to a dialysis machine which drawsblood through the extraction lumen 50 and returns it through returnlumen 52 in a similar manner to a conventional dual lumen cannula.Between blood treatments the lumens may be filled with a heparinsolution to prevent them from being filled with clotted blood. However,if the patient requires medication or is required to give blood betweentreatments, the IV lumens 54 may be used. This avoids the trauma anddiscomfort of inserting a further needle or catheter into the patientand does not disturb the heparin lock.

Between uses the third lumen may be filled with a relatively smallvolume of heparin or may be occupied by cylindrical solid and flexiblepatency obturator, similar to guide wire 21. This obturator prevents theentrance of blood into the lumen and thus eliminates the need forheparin in the third lumen. Generally, it will be easier to keep thethird lumen free of blood due to its smaller cross-section, regularshape and absence of side holes.

In addition to this advantage the centrally located lumen offersconsiderable advantages for insertion and removal of the catheter. Asthere are no side holes in the lumen, "J" ended guide wires may be usedwithout the possibility that the guidewire will exit through a sidehole, rather than the end aperture. In addition, because it is easier tokeep the smaller lumen free of clotted blood, it should be possible touse a guidewire to replace a catheter which has clotted blood in theblood lumens without dislodging any blood clots which may haveaccumulated in the blood lumens. This would be done by first enteringthe Seldinger wire into the third lumen of the catheter in place in thevein, withdrawing this catheter over the wire leaving the wire in place,and then using the wire to guide a replacement catheter over the guidewire.

The exemplary catheter described with reference to the drawings does nothave the proportions of a haemodialysis catheter. As mentionedpreviously, the description is exemplary and in practice, if thecatheter is to be used in the subclavian vein it will have proportionsas follows. The central lumen will have a diameter of about 0.04 inchesto receive a Seldinger wire of diameter 0.038 inches or 0.036 inches.The walls about the central lumen and forming the septum will be about0.010 inches in thickness and will blend into the outer wall which isabout 0.013 inches in thickness. The outer diameter of the body 26 willbe 0.149 inches and this will give an area available for blood flow inthe lumens of about 0.0048 square inches. The flow rate will beapproximately 237 millilitres per minute using accepted pressures todrive the blood through the lumens.

Clearly catheters can be made with a variety of proportions dependingupon the use and structures defined by the claims and incorporating thedescription are within the scope of the invention.

The tip structure shown in FIG. 3 can be made in a number of ways. Analternative is shown in FIGS. 13 and 14. For ease of reference thereference numerals used in relation to these figures correspond to thoseused above prefixed with the numeral 1. The distal end 128 and tip 129of a catheter 126 has inserts 156, 160 which extend to fill the unusedportions of the extraction and return lumens. The inserts are entered inthe lumens 150, 152 and may be affixed therein by a solvent. When theend 128 is heated in the mould the inserts 156, 160 are softened anddeformed and the outer wall 146 collapses to merge with the septum 148.The leading ends of the inserts 156, 160 also merge with the septum 148,as represented by the ghost outlines in FIGS. 13 and 14. The resultingcatheter has an appearance similar to the catheter described above witha tip opening 164, but with a stiffer leading end.

It will be evident that the form of the inserts can vary. For instancethe ends originally near the end 128 could be thinned to allow foreasier deformation of the extrusion into the shape shown in FIG. 13.

The catheters illustrated and described above feature septums having abulbous middle portion 153 to accommodate the IV lumen 154. However, thecatheter of the invention is not limited to this particularcross-section and FIG. 15 shows an alternative cross-section. For easeof reference the numerals used in relation to this figure correspond tothose used to describe the preferred embodiment prefixed with thenumeral 2. The catheter 226 illustrated has a septum 248 with planarsides such that the extraction and return lumens 250, 252 have aD-shaped cross-section. This thicker septum 248 requires the use of morematerial to form the catheter and also reduces the ratio between thecross-sectional area of the extraction and return lumens and thecross-sectional area of the catheter. However, there may be uses abovewhere this cross-section is advantageous, for instance, where the outerdiameter of the catheter body is less critical than it is when used in avein for haemodialysis.

Reference is now made to FIG. 16 to describe a moulded plug ofpolyurethane for use in making tips. This plug P has end pieces 200,202shaped to fit snugly in the lumens 50, 52 (FIG. 3). The end pieces areattached to respective spacers 204,206 which depend from a hub 208 atrespective weakened joints 210,212. The hub has a central opening 214matching the third IV lumen 254 so that the wire used in moulding can beused to locate the hub centrally.

The procedure, when using the plug P of FIG. 16, is to first bend thespacers 204,206 about the joints 210,212 so that the end pieces 200,202come together for insertion in the end of the extruded body 26. Thepieces are pushed home with solvent until the hub 208 meets the end ofthe body. The pieces 200,202 will then automatically be in the requiredpositions controlled by the lengths of the spacers 204,206. Mouldingthen proceeds as before so that the hub and adjacent parts of thespacers will become integral portions of the tip.

A further embodiment is shown in FIG. 17. This structure includes aseparate moulded tip 216 preferably of polyurethane, which is engaged inand bonded to distal end F of an extruded catheter body E. The tip 216has an outer conical form and defines a central opening 218 at one endof a central passageway G that forms a continuation of the third lumen220. A pair of extensions 222, 224 are shaped to fit in the respectivelumens 226, 228 and have lengths to match the positions of the apertures230,232 in the side wall of the lumens. The ends of the extensions arepreferably shaped to meet the apertures and complement the natural flowpatterns so that dead spaces will be minimized, if not eliminated.

The structure shown in FIG. 17 can also be partly formed by heating in amould to blend the joint between the tip and the extrusion. Thistechnique can also be used to part form the assembly to improve the tip,if necessary.

The method of shaping the end is described as utilizing radio frequencyheating devices to soften the plastic material. This is intended to beillustrative of a softening technique, and other techniques, forexample, the use of electrical heating elements, are equally effective.

The third method of manufacturing the tip is illustrated in FIG. 18.Numerals corresponding to those used in FIG. 3 will be repeated with aprefix "3".

In this embodiment, a body 326 receives an extension piece 400 shaped tofit roughly on the end of the body and having a projection 402 of theshape needed as a continuation of the central aperture or third lumen.The parts are located relative to one another by a central rod 404within two halves 406, 408 of a heated dye shaped to correspond to thetip shape shown in FIG. 3. This shape can of course be modified toprovide varying ends on the catheter depending upon the desiredconfiguration.

The body 326 receives first and second mandrels 410, 412 shaped to fitwithin the lumens 350, 352 and positioned so that material flowing underthe influence of the heat will engage with the ends of the mandrels in afashion corresponding to the plugs 56, 60 shown in FIG. 3. The resultwill be continuous material from the distal end of the catheter to theends of the mandrels 410,412. The shaping can be seen in FIG. 3 butwithout the spacing between the plugs 56, 60 and the solid end of thecatheter.

Under the influence of heat, the material of the body 326 and extension400 will flow and be shaped by the closing dye halves 406, 408. Thenecessary quantity of material required to complete the shape can beaugmented by the provision of plugs in the lumens 350, 352 of a materialwhich will also flow under the influence of heat. However, with somecare in design, it is possible to complete the tip without the use ofthese plugs.

The structure shown in FIG. 18 has the advantage that the extension 400can be of any durometer hardness require, consistent of course with thematerial matching that of the body 326. Consequently, it is possible tocreate a distal end on the tip having different characteristics from themain body. The very end of the catheter can be quite soft so that, whenit is inserted, it will have minimal strength and therefore reduce therisk of damage to the wall of the vein after insertion. Such a tip maywell make it possible to leave the catheter in place for longer periodsthan would be possible with a tip having a stiff end.

Reference is now made to FIG. 19 which illustrates a further embodimentof tip made using the method of FIG. 18. As mentioned, the mould housecan be of different shapes and the shapes chosen to make the structurein FIG. 19 provide a cylindrical central extension 414 made from a partsimilar to that identified as 402 in FIG. 18. There is a transition zonedefining a shoulder 416 where the extension 414 blends smoothly into thebody 326. In this embodiment, to provide sufficient material to blockthe lumens 350, 352, plugs 418 and 420 are provided and these flow intothe material around them as indicated by the broken outline at theshoulder 416. With a suitable selection of material, it is possible toprovide the extension 414 with significantly different physicalcharacteristics from the body, notably it can be made of soft materialwhich will have very little effect on the inner wall surface of a vein.Similarly, the strength at the shoulder can be changed by using insertsof soft material or even providing plugs rather than inserts in themanner described with reference to FIG. 3.

Structures such as shown in FIGS. 3, 13, and 19 are exemplary of tipswhich are tapered. Some are frustro-conical whereas others tend to havea shoulder such as that shown in FIG. 19. However, functionally they areall tapered since they will dilate tissue as they are moved along aSeldinger wire into position in a patient. For this reason, in theterminology of this application, the word "tapered" is intended toinclude any structure at the end which is capable of such dilation.

It will be appreciated that various other modifications may be made tothe catheter, and to the processes for making parts of the catheter asdescribed, without departing from the scope of the invention, forexample, the material used to form the tube and inserts may be anysuitable medical grade thermoplastic. Also, the positioning of theapertures and the number of apertures is to some extent a matter ofchoice. Also the length of the conical tip can be varied to includeapertures in the wall of the tip. While such a structure is morecomplicated to make, the flow pattern would be advantageous.

Although the catheter has been described in use in haemodialysis in asubclavian vein, it would also be appreciated that it can be used inboth femoral and jugular veins, and can also be used in other bloodtreatments including apheresis, haemoperfusion and non-blood relatedtreatments involving nutrition and drug therapies.

It is claimed:
 1. A multiple lumen catheter comprising:a) a flexibleelongate catheter body extending about a longitudinal axis andhaving:(i) a distal end with a tapered tip, (ii) a proximal end, (iii)an outer wall, and (iv) a septum extending between spaced points on theinterior of said outer wall; b) said outer wall of said catheter bodyand said septum together defining first and second lumens, c) said outerwall further defining respective first and second apertures providingfor fluid communication between said first and second lumens,respectively, and the exterior of said catheter body, said first andsecond lumens extending from said proximal end of said catheter body tosaid first and second apertures, respectively; and d) a portion of saidseptum defining a third lumen, said third lumen having a cross-sectionalarea substantially smaller than that of either of said first and secondlumens, and said third lumen extending centrally along said catheterbody from said proximal end thereof to said distal end thereof, and saidthird lumen being separated from said first and second lumens by saidseptum, e) said third lumen terminating at the distal terminus of saidtapered tip in a third aperture.
 2. A catheter as recited in claim 1,wherein said proximal end of said catheter body is provided with acollar carrying wing tabs for attaching the catheter to the skin of apatient after insertion of the catheter, said collar being rotatablymounted on said proximal end of said catheter body.
 3. A catheter asrecited in claim 2, wherein said collar is retained on said proximal endof said catheter body by first and second retaining portions, each ofsaid retaining portions being formed of a collar bonded to said catheterbody.
 4. A catheter as recited in claim 1, wherein said catheter bodyfurther comprises:(a) a first solid portion located interior of saidouter wall in said first lumen and distal of said first aperture; and(b) a second solid portion located interior of said outer wall in saidsecond lumen and distal of said second aperture.
 5. A catheter asrecited in claim 4, wherein said first solid portion extends from saidfirst aperture to said taper tip.
 6. A catheter as recited in claim 4,wherein said first solid portion extends distally from said firstaperture to a location proximal of said tapered tip.
 7. A catheter asrecited in claim 1, wherein said first aperture is located further fromsaid distal terminus of said tapered tip than said second aperture.
 8. Acatheter as recited in claim 1, wherein said outer wall of said catheterbody converges radially inwardly at said tip to present a smoothtransition from the cross section of said catheter body to a smallercross section at said distal terminus of said tip.
 9. An elongatecatheter, said catheter having distal and proximal ends, and saidcatheter comprising:(a) a flexible elongate catheter body extendingabout a longitudinal axis; (b) a tapered tip at said distal end of saidcatheter, (c) said catheter body defining first and second side lumensand a third lumen; (d) said first and second side lumens and said thirdlumen extending from said proximal end of said catheter to first,second, and third apertures, respectfully;(i) said first and second sidelumens having similar shapes in cross section and terminating at firstand second side apertures, respectively; (ii) said third lumen extendingcentrally along said longitudinal axis of said catheter body betweensaid first and second lumens along the length of said catheter body andending at said third aperture at said distal end of said catheter, saidthird lumen being smaller in cross-sectional area than either of saidfirst and second side lumens, and said third lumen being proportioned toslidably receive a guide wire during insertion of said catheter into thebody of a patient.
 10. A catheter comprising:(a) a smooth elongateflexible cylindrical body having:(i) proximal and distal ends, (ii) anouter wall, and (iii) a septum extending between diametrically spacedpoints on said outer wall, thereby to define interior of saidcylindrical body similar first and second fluid flow lumens, and (b)said septum further defining centrally within said septum a circularfluid flow lumen disposed about the longitudinal axis of saidcylindrical body and being substantially smaller in a cross-sectionalarea than individual of said first and second fluid flow lumens; (c) atip at said distal end of said cylindrical body, the outer surface ofsaid tip blending smoothly into the outer surface of said cylindricalbody, in a direction from said cylindrical body toward the distalterminus of the catheter said outer surface of said tip convergingradially inwardly toward said longitudinal axis of said cylindrical bodyand defining at said distal terminus of the catheter an aperture at theend of said circular fluid flow lumen; (d) access means attached to saidproximal end of said cylindrical body for providing access thereat tosaid first and second fluid flow lumens and to said circular fluid flowlumen; and (e) said cylindrical body defining the following:(i) a firstside aperture adjacent said distal terminus of the catheter andcommunicating through said outer wall with said first fluid flow lumen,and (ii) a second side aperture spaced towards said proximal end of saidcylindrical body from said first aperture and communicating through saidouter wall with said second fluid flow lumen.
 11. A catheter as recitedin claim 10, further comprising rotatable attachment means adjacent saidaccess means for securing the catheter to the skin of a patient.
 12. Acatheter as recited in claim 10, wherein said first and second fluidflow lumens terminate immediately adjacent the respective distalextremities of said first and second side apertures, respectively.
 13. Acatheter as recited in claim 10, wherein said tip comprises a separatepiece from said cylindrical body, said separate piece having first andsecond projections engaged from said distal end of said cylindrical bodyin said first and second fluid flow lumens, respectively, and fillingsaid first and second fluid flow lumens to the extend of said distalextremity of said first and second side apertures, respectfully, whensaid separate piece is attached to said distal end of said cylindricalbody.
 14. A triple lumen catheter comprising:(a) An elongate catheterbody extending about a longitudinal axis from a proximal to a distalend; (b) a tapered tip at said distal end of said catheter body; (c)said catheter body having an outer wall and an internal septum, saidseptum in combination with said outer wall defining C-shaped first andsecond lumens longitudinally extending within said catheter body; (d)said outer wall of said body defining first and second apertures, saidfirst aperture being spaced longitudinally from said tapered tip andfrom said second aperture, and said second aperture being locatedbetween said first aperture and said tapered tip; (e) said first lumenterminating at said first aperture, and said second lumen terminating atsaid second aperture; (f) said septum defining a circular third lumensmaller than said first lumen and smaller than said second lumen, saidthird lumen terminating at the distal terminus of said tapered tip; (g)the outer surfaces of said catheter body and said tapered tip combiningto present a smooth transition from the cross section of said catheterbody to a smaller cross section at said distal terminus of said taperedtip.
 15. A catheter as recited in claim 14, further comprising:(a) aconnector attached to said proximal end of said body; (b) first andsecond access tubes attached to said connector, said first and secondaccess tubes being coupled by said connector to said first and secondlumens, respectively; and (c) a third access tube smaller than either ofsaid first and second access tubes, said third access tube beingattached to said connector and coupled by said connector to said thirdlumen.
 16. A catheter as recited in claim 14, wherein said third lumenis proportioned to slidably receive a guidewire during insertion of thecatheter through the skin of a patient.
 17. A catheter as recited inclaim 14, wherein said first and second lumens are sized to allowadequate flow rates for haemodialysis therapy, when said first lumen isused to withdraw blood from a vein of a patient for cleansing, and saidsecond lumen is used to return blood to the vein after cleansing.
 18. Acatheter as recited in claim 14, wherein the distance from said firstaperture to said second aperture is sufficiently large for efficienthaemodialysis therapy, when said first lumen is used to withdraw bloodfrom a vein of a patient for cleansing, and said second lumen is used toreturn blood to the vein after cleansing.
 19. A catheter as recited inclaim 14, wherein said third lumen is located at the midpoint of saidseptum.
 20. A catheter comprising:(a) an elongate body extending from aproximal to a distal end, said elongate body defining the following:(i)two similar longitudinally extending lumens separated by a septum; and(ii) a further lumen defined within the septum; (b) a tip extending fromthe distal end of said elongate body defining a part of said furtherlumen; (c) a connector at said proximal end of said elongate body; (d)tubes coupled to the connector and in fluid communication through theconnector one with each of the respective lumens defined by saidelongate body; (e) said elongate body defining openings providing accessone to each of the longitudinally extending lumens, said openings beingspaced from one another longitudinally of said elongate body, and saidfurther lumen extending longitudinally beyond said longitudinallyextending lumens and through the tip; (f) the further lumen terminatingat an opening at the distal end of the tip, and the tip beingconvergently tapered as it extends longitudinally from said elongatebody; and (g) the longitudinally extending lumens being blockedimmediately adjacent and distally of said openings.
 21. A catheter asrecited in claim 20, in which said elongate body is circular incross-section.
 22. A catheter as recited in claim 20, in which thelongitudinally extending lumens are generally C-shaped in cross-section.23. A catheter as recited in claim 20, in which the connector istrident-shaped.